High-intensity statins do save lives, says US study

A US-based study of more than 500,000 patients with atherosclerotic cardiovascular disease (ASCVD) found that those who received high-intensity statins saw their mortality risk significantly reduced.

The study, published online by JAMA Cardiology, examined one-year cardiovascular mortality rates by intensity of statin therapy among patients aged 21 to 84 years with ASCVD treated under the Veteran Affairs health care system.

The study sample included 509, 766 eligible adults with ASCVD at study entry, including 30 per cent receiving high-intensity statin therapy, 46 per cent receiving moderate-intensity stain therapy, 6.7 per cent receiving low-intensity statin therapy, and 18 per cent receiving no statins. The intensity of the statin therapy was defined by the 2013 American College of Cardiology and the American Heart Association guidelines, and use was defined as a filled prescription in the prior six months.

During an average follow-up of 492 days, there was a graded association between intensity of statin therapy and mortality. The researchers also found that maximal doses of high-intensity statins conferred the greatest survival advantage compared with submaximal doses of high-intensity statins.

Statin therapy remains the cornerstone for the prevention of ASCVD. Many large, randomised trials have shown that the use of statins significantly reduces the likelihood of future cardiovascular events and mortality in diverse populations. Nevertheless, statin therapy in general, and high-intensity statin therapy in particular, is underused in patients with established ASCVD. The Veterans Affairs health care system has released dyslipidemia guidelines that recommend moderate-intensity statins for most patients with ASCVD, citing insufficient evidence for recommending high-intensity statin therapy except in some subgroups of patients at high risk for ASCVD.

Paul A. Heidenreich from Stanford University and his colleagues wrote that the study offered evidence to significantly improve the treatment of ASCVD.

“These findings suggest there is a substantial opportunity for improvement in the secondary prevention of ASCVD through optimization of intensity of statin therapy,” they wrote.